Fiedler John L, Helleranta Meri
Harvest Plus, International Food Policy Research Institute, Washington DC, USA.
Food Nutr Bull. 2010 Jun;31(2):251-69. doi: 10.1177/156482651003100208.
Fortification offers great potential for reducing the enormous disease burden of micronutrient deficiencies. The lack of information on food consumption patterns has been a major impediment to the development of fortification programs. In some countries, the absence of this information has been an obstacle to the introduction of fortification. In countries that have fortification, governments are increasingly being challenged to provide evidence that programs are well designed and effective.
To examine the usefulness of household income and expenditure surveys (HIES) as a means for addressing this information gap and making fortification programs more evidence-based and more accountable.
Data from Guatemala's 2005/6 Living Standards Measurement Survey are used to develop a measure of "apparent food consumption". The measure is used to assess Guatemala's fortification program by analyzing the coverage and the additional micronutrient intake attributable to different food vehicles, combinations of food vehicles, and fortification formulations.
There are three key findings. The impact of the wheat flour fortification program is considerably greater than had previously been estimated; the level at which sugar is currently fortified with vitamin A may be excessive and should be reviewed; and fortifying semolina flour (used to make pasta) would extend the benefits of wheat flour fortification to 60,000 households that currently do not benefit from it and would increase the amount of fortified food consumed by 68% of the population. Beneficiaries would include 63% of the extreme poor, and the greatest benefits would go to those wheat flour consumers who currently benefit the least from consuming fortified wheat flour products.
HIES data should be used more routinely as a tool in the designing, monitoring, and assessing of fortification programs.
强化措施在减轻微量营养素缺乏所带来的巨大疾病负担方面具有巨大潜力。缺乏关于食物消费模式的信息一直是强化计划制定过程中的主要障碍。在一些国家，缺少此类信息已成为引入强化措施的阻碍。在已实施强化措施的国家，政府越来越面临着提供证据以证明这些计划设计良好且有效的挑战。
研究家庭收入和支出调查（HIES）作为填补这一信息空白并使强化计划更具循证性和问责性的手段的有用性。
利用危地马拉2005/6年生活水平测量调查的数据来制定“表观食物消费”的衡量标准。该衡量标准通过分析不同食物载体、食物载体组合以及强化配方的覆盖范围和额外微量营养素摄入量，用于评估危地马拉的强化计划。
有三项关键发现。小麦粉强化计划的影响比之前估计的要大得多；目前维生素A强化糖的水平可能过高，应予以审查；强化粗粒面粉（用于制作意大利面）将使小麦粉强化的益处扩大到目前未从中受益的6万户家庭，并使68%的人口消费的强化食品量增加。受益者将包括63%的极端贫困人口，并将使那些目前从食用强化小麦粉产品中受益最少的小麦粉消费者获得最大益处。
HIES数据应更常规地用作强化计划设计、监测和评估的工具。
